Clinical Care

We feel strongly that the best way to learn pediatric neurology is to do it. Pediatric neurology residents have the opportunity to develop their skill managing an extensive variety of patients in both the outpatient and inpatient settings.

Outpatient:

Starting in the PGY3 year (i.e. the initial neurology year spent primarily on the adult neurology service) the weekly resident continuity clinic is a critical element of the pediatric neurology training program. Residents see patients specifically assigned to them and follow them longitudinally through their three years of training. The residents also handle outpatient management issues for their patients over the phone between visits. The goal is for them to essentially have their own “practice” during those 3 years of training.

During the PGY4 and PGY5 years residents spend 4 months of the year working in the outpatient pediatric neurology clinics. Residents see patients in sub-specialty clinics such as epilepsy, movement disorders, cerebral palsy, neurorehabilitation, neuromuscle, neurofibromatosis, tuberous sclerosis, Rett syndrome, neuroimmunology, neonatal neurology, and headache. During the PGY4 and PGY5 year residents can spend dedicated elective time in any of the subspecialty clinics or other clinics such as neuro-ophthalmology, neuro-otology, neuro-oncology, neurocritical care follow-up, genetics, sleep medicine, and others.

Inpatient:

On inpatient rotations residents supervise the care of patients on the neurology ward service and consult on patients with neurological problems on other floors of the hospital and in the emergency department. St. Louis Children’s Hospital provides tertiary and quaternary care for the city of St. Louis, the surrounding region, the Midwest, the US, and international patients. Thus, the variety of patients our residents see is outstanding. We also have strong relationships with the intensive care units in the hospital which include the Pediatric Intensive Care Unit, Neonatal Intensive Care Unit, and Cardiac Intensive Care Unit. Our frequent consults there give our residents the chance to further develop their skills in critical care neurology. Our division policy is that generally any patient admitted to the hospital who does not have a neurologist will follow-up with the resident that cares for them if out-patient follow-up is needed.

Although in-house call is taken during the PGY3 adult neurology year, all call during the PGY4 and PGY5 year is at home. At night during the last two years the on-call resident takes the first call responsibility for out-patient issues for all faculty and resident patients, phone consultation for outside emergency departments generally in the Missouri/Illinois area, and calls from the St. Louis Children’s emergency department and in-patient services. At night there is always attending backup for any issue that the resident needs assistance in managing. Our attendings encourage residents to call with any questions.

Electrophysiology:

Electrophysiological tests are a common tool in pediatric neurology. Residents can obtain experience in EMG during the outpatient portion of their adult time in PGY3 year, as there is a dedicated neuromuscle clinic day every week of this rotation. During in-patient rotations, residents get extensive experience with EEG and video EEG monitoring. Residents can spend additional time learning these modalities during the elective portion of their PGY4 and PGY5 year.